Background: The mini-Balance Evaluation Systems Test (mini-BESTest) is a valid tool for assessing standing balance in people with spinal cord injury (SCI). Its reliability has not yet been investigated with this population. Objective: To assess the test-retest and inter-rater reliability of the mini-BESTest in adults with SCI in a rehabilitation setting. Methods: Twenty-three participants admitted in a rehabilitation center following an SCI (mean age = 52.2 years, SD = 14.5; 13/23 tetraplegia; 14/23 traumatic injury) and able to stand 30 seconds without help were recruited. They were evaluated twice with the mini-BESTest to establish the test-retest reliability (interval of 1 to 2 days). One of the two sessions was video-recorded to establish the inter-rater reliability (3 physiotherapists). Intraclass correlation coefficients (ICC2,1), weighted kappa (K-w) and Kendall's W were used to determine reliability of total score and individual items. Minimal detectable changes (MDC) were computed. Results. The mini-BESTest total scores showed excellent test-retest (ICC = 0.94) and inter-rater (ICC = 0.96) reliability. Reliability of 50% of the individual items was acceptable to excellent (Kappa(w) and W = 0.35-1.00). The MDC of the mini-BESTest total score was 4 points. Conclusion: The mini-BESTest is a reliable tool to assess standing balance in adults with an SCI. A minimal change of 4 points on the total scale is needed to be confident that the change is not a measurement error between two sessions or two raters.

The Mini BESTest has been developed to comprehensively examine postural control in individuals with various pathologies treated by rehabilitation professionals. However, no formal French version of the Mini BESTest is available. This study aimed to translate and transculturally adapt the Mini BESTest to French and verify its intra- blished guidelines, which included 2 initial translations and transcultural adaptations of the Mini BESTest to French that were then merged, a backward English translation, a subsequent adapted French version resolving discrepancies between the English versions, and pilot testing the final version by French-speaking physical therapists. In total, 20 participants with sensorimotor impairments with various etiologies and able to stand for at least 30 sec without human or technical assistance were video-recorded during evaluation with the Mini BESTest. From this video-recording, we calculated inter-rater and intrarater reliability (intraclass correlation coefficient = 0.974-0.988), internal consistency (Cronbach alpha = 0.895-0.929), standard error of measurement (1.05 and 1.63), and minimal detectable change at the 95% confidence interval (2.91 and 4.51). All values were comparable to those previously reported for the original version of the Mini BESTest. Furthermore, no significant ceiling or floor effect was detected. Therefore, the translated and transculturally adapted version of the Mini BESTest in French compares well to the original version and can be used by French-speaking rehabilitation professionals to examine postural control. (C) 2018 Published by Elsevier Masson SAS.

First Place Award Submission - CA147Category: Clinical ApplicationManagement of obesity after spinal cord injury: a systematic reviewMir Hatef Shojaei1, Mohammad Alavinia1, B. Catharine Craven1,21N...

Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.

OBJECTIVE:To quantify and compare the responsiveness and concurrent validity of 3 performance-based manual wheelchair propulsion tests among manual wheelchair users with subacute spinal cord injury (SCI) undergoing inpatient rehabilitation.DESIGN:Quasi-experimental repeated-measures design.SETTING:Publicly funded comprehensive inpatient SCI rehabilitation program.PARTICIPANTS:Consenting adult manual wheelchair users with a subacute SCI admitted and discharged from inpatient rehabilitation (N=14).INTERVENTION:Participants performed 20-m propulsion at both self-selected natural and maximal speeds, the slalom, and the 6-minute propulsion tests at rehabilitation admission and discharge.MAIN OUTCOME MEASURES:Time required to complete the performance-based wheelchair propulsion tests. Standardized response means (SRMs) were computed for each performance test and Pearson correlation coefficients (r) were calculated to explore the associations between performance tests.RESULTS:The slalom (SRM=1.24), 20-m propulsion at maximum speed (SRM=.99), and 6-minute propulsion tests (SRM=.84) were the most responsive. The slalom and 20-m propulsion at maximum speed were strongly correlated at both admission (r=.93) and discharge (r=.92).CONCLUSIONS:The slalom and 6-minute propulsion tests best document wheelchair propulsion performance change over the course of inpatient rehabilitation. Adding the 20-m propulsion test performed at maximal speed provides a complementary description of performance change.

The association between upper extremity (U/E) and trunk strength as well as seated postural stability with wheelchair propulsion performance has not been evaluated. Consequently, it remains unknown to what extent U/E and trunk strength and seated postural stability contribute to manual wheelchair propulsion performance. Gaining additional knowledge with regards to these modifiable contributors may provide guidance to rehabilitation professionals, particularly to physiotherapists, for selecting and prioritizing therapeutic interventions aiming to improve manual wheelchair performance, aside from those focusing on developing optimal propulsion techniques To quantify the association between performance-based manual wheelchair propulsion tests (i.e., 20-m propulsion test, slalom test, and 6-min propulsion test), trunk and U/E strength as well as seated reaching capability to establish which trunk and U/E strength or seated reaching capability measures best predict performance on timed manual wheelchair propulsion tests completed at discharge from inpatient rehabilitation by individuals with a spinal cord injury (SCI). Fifteen individuals with a SCI performed the 20-meter, slalom and 6-minute wheelchair propulsion tests within 72 hours prior to discharge from comprehensive inpatient SCI rehabilitation. Trunk and U/E strength along with seated reaching capability with unilateral hand support were also measured. The relationships between the wheelchair propulsion tests and the other variables were assessed using bi-variate correlation and multiple linear regression analyses. The 20-meter propulsion-maximum velocity, slalom and 6-minute propulsion tests were moderately or strongly correlated with anterior and lateral inclination trunk strength, seated anterior reaching distance and the majority of shoulder, elbow and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. U/E strength, especially of the shoulder adductors and handgrip, and forward seated reaching capability may be important determinants and predictors of performance during manual wheelchair propulsion tests. Specific rehabilitation interventions targeting these modifiable personal characteristics during rehabilitation may enhance manual wheelchair propulsion ability.

Context: Trunk control is essential to engage in activities of daily living.Measuring trunk strength and function in persons with spinal cord injury (SCI) is difficult.Trunk function has not been studied in non-traumatic SCI (NTSCI).Objectives: To characterize changes in trunk strength and seated functional reach in individuals with NTSCI during inpatient rehabilitation.To determine if trunk strength and seated reach differ between walkers and wheelchair users.To explore relationships between trunk and hip strength and seated functional reach.Design: Observational study.Setting: Two SCI rehabilitation facilities.Participants: 32 subacute inpatients (mean age 48.0 ± 15.4 years).Outcome measures: Isometric strength of trunk and hip and function (Multidirectional Reach Test: MDRT) were assessed at admission and within 2 weeks of discharge.Analysis of variance was conducted for admission measures (MDRT, hip and trunk strength) between walkers and wheelchair users.Changes in MDRT, hip and trunk strength were evaluated using parametric and non-parametric statistics.The level of association between changes in values of MRDT and strength was also examined.Results: Significant differences between walkers and wheelchair users were found for strength measures (P < 0.05) but not for MDRT.Left-and right-sided reaches increased in wheelchair users only (P < 0.05).Associations between changes in hip strength, trunk strength, and reach distance were found (R = 0.67-0.73). Conclusion:In clinical settings, it is feasible and relevant to assess trunk, hip strength, and MRDT.Future studies require strategies to increase the number of participants assessed, in order to inform clinicians about relevant rehabilitation interventions.